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The Cochrane Database of Systematic... Feb 2018The optimal treatment of superficial thrombophlebitis (ST) of the legs remains poorly defined. While improving or relieving the local painful symptoms, treatment should... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The optimal treatment of superficial thrombophlebitis (ST) of the legs remains poorly defined. While improving or relieving the local painful symptoms, treatment should aim at preventing venous thromboembolism (VTE), which might complicate the natural history of ST. This is the third update of a review first published in 2007.
OBJECTIVES
To assess the efficacy and safety of topical, medical, and surgical treatments for ST of the leg in improving local symptoms and decreasing thromboembolic complications.
SEARCH METHODS
For this update, the Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register (March 2017), CENTRAL (2017, Issue 2), and trials registries (March 2017). We handsearched the reference lists of relevant papers and conference proceedings.
SELECTION CRITERIA
Randomised controlled trials (RCTs) evaluating topical, medical, and surgical treatments for ST of the legs that included people with a clinical diagnosis of ST of the legs or objective diagnosis of a thrombus in a superficial vein.
DATA COLLECTION AND ANALYSIS
Two authors assessed the trials for inclusion in the review, extracted the data, and assessed the quality of the studies. Data were independently extracted from the included studies and any disagreements resolved by consensus. We assessed the quality of the evidence using the GRADE approach.
MAIN RESULTS
We identified three additional trials (613 participants), therefore this update considered 33 studies involving 7296 people with ST of the legs. Treatment included fondaparinux; rivaroxaban; low molecular weight heparin (LMWH); unfractionated heparin (UFH); non-steroidal anti-inflammatory drugs (NSAIDs); compression stockings; and topical, intramuscular, or intravenous treatment to surgical interventions such as thrombectomy or ligation. Only a minority of trials compared treatment with placebo rather than an alternative treatment and many studies were small and of poor quality. Pooling of the data was possible for few outcomes, and none were part of a placebo-controlled trial. In one large, placebo-controlled RCT of 3002 participants, subcutaneous fondaparinux was associated with a significant reduction in symptomatic VTE (risk ratio (RR) 0.15, 95% confidence interval (CI) 0.04 to 0.50; moderate-quality evidence), ST extension (RR 0.08, 95% CI 0.03 to 0.22; moderate-quality evidence), and ST recurrence (RR 0.21, 95% CI 0.08 to 0.54; moderate-quality evidence) relative to placebo. Major bleeding was infrequent in both groups with very wide CIs around risk estimate (RR 0.99, 95% CI 0.06 to 15.86; moderate-quality evidence). In one RCT on 472 high-risk participants with ST, fondaparinux was associated with a non-significant reduction of symptomatic VTE compared to rivaroxaban 10 mg (RR 0.33, 95% CI 0.03 to 3.18; low-quality evidence). There were no major bleeding events in either group (low-quality evidence). In another placebo-controlled trial, both prophylactic and therapeutic doses of LMWH (prophylactic: RR 0.44, 95% CI 0.26 to 0.74; therapeutic: RR 0.46, 95% CI 0.27 to 0.77) and NSAIDs (RR 0.46, 95% CI 0.27 to 0.78) reduced the extension (low-quality evidence) and recurrence of ST (low-quality evidence) in comparison to placebo, with no significant effects on symptomatic VTE (low-quality evidence) or major bleeding (low-quality evidence). Overall, topical treatments improved local symptoms compared with placebo, but no data were provided on the effects on VTE and ST extension. Surgical treatment combined with elastic stockings was associated with a lower VTE rate and ST progression compared with elastic stockings alone. However, the majority of studies that compared different oral treatments, topical treatments, or surgery did not report VTE, ST progression, adverse events, or treatment adverse effects.
AUTHORS' CONCLUSIONS
Prophylactic dose fondaparinux given for 45 days appears to be a valid therapeutic option for ST of the legs for most people. The evidence on topical treatment or surgery is too limited and does not inform clinical practice about the effects of these treatments in terms of VTE. Further research is needed to assess the role of rivaroxaban and other direct oral factor-X or thrombin inhibitors, LMWH, and NSAIDs; the optimal doses and duration of treatment in people at various risk of recurrence; and whether a combination therapy may be more effective than single treatment. Adequately designed and conducted studies are required to clarify the role of topical and surgical treatments.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Factor Xa Inhibitors; Fondaparinux; Hemorrhage; Heparin, Low-Molecular-Weight; Humans; Polysaccharides; Randomized Controlled Trials as Topic; Rivaroxaban; Stockings, Compression; Thrombectomy; Thromboembolism; Thrombophlebitis; Venous Thromboembolism
PubMed: 29478266
DOI: 10.1002/14651858.CD004982.pub6 -
Seminars in Cutaneous Medicine and... Jun 2007Superficial thrombophlebitis (STP) is a common disease usually characterized by an auto-resolving vasculitis of medium-sized veins of the upper subcutis or deep dermis... (Review)
Review
Superficial thrombophlebitis (STP) is a common disease usually characterized by an auto-resolving vasculitis of medium-sized veins of the upper subcutis or deep dermis that clinically manifests as a tender or painful palpable cord-like structure. It usually occurs in the setting of varicous veins, or hypercoagulable states, and may be the alarm signal for an underlining silent cancer. STP mainly involves the legs, but special locations, including the anterior chest wall or the penis, characterize specific clinical forms (Mondor's disease). The clinical signs and symptoms usually allow an easy diagnosis, but complementary techniques and biopsy are sometimes required. The main histopathologic differential diagnosis of STP is cutaneous polyarteritis nodosa.
Topics: Diagnosis, Differential; Humans; Thrombophlebitis
PubMed: 17544957
DOI: 10.1016/j.sder.2007.02.002 -
BMJ (Clinical Research Ed.) Jun 2015
Review
Topics: Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Femoral Vein; Humans; Incidence; Ligation; Practice Guidelines as Topic; Referral and Consultation; Saphenous Vein; Severity of Illness Index; Stockings, Compression; Thrombophlebitis; Ultrasonography
PubMed: 26099257
DOI: 10.1136/bmj.h2039 -
Journal of the European Academy of... Feb 2023Superficial (nodular) thrombophlebitis, referring to a thrombo-inflammatory disorder of dermal-subcutaneous veins, encompass a spectrum of nodular lesions often... (Review)
Review
BACKGROUND
Superficial (nodular) thrombophlebitis, referring to a thrombo-inflammatory disorder of dermal-subcutaneous veins, encompass a spectrum of nodular lesions often associated with inflammatory, infectious, neoplastic or thrombophilic diseases.
OBJECTIVE
We postulate that distinct clinico-pathological features may correlate with the underlying conditions.
METHODS
We conducted a retrospective monocentric study of all patients seen in our dermatology department for a superficial thrombophlebitis, completed with a literature review. Clinical and pathological data were extracted from the patient files and articles.
RESULTS
A total of 108 cases of superficial thrombophlebitis was analysed. Forty-five percent manifested as elongated nodules clearly evoking vascular involvement, while the other 55% were presenting as nodules or plaques. The elongated phenotype was strongly associated with malignancy or thrombophilia if a pure thrombosis was demonstrated histopathologically, while tuberculosis was the main underlying condition if a granulomatous vasculitis was present. Panniculitis-like lesions were mainly corresponding to erythema-nodosum-like lesions of Behçet's disease, characterized by the distinctive feature of thrombotic veins with an associated leukocytoclastic vasculitis.
LIMITATIONS
Retrospective design and risk of publication bias.
CONCLUSION
Superficial (nodular) thrombophlebitis is a heterogeneous entity with a distinct clinico-pathological presentation that strongly points to the nature of the underlying medical condition, thus guiding the medical workup.
Topics: Humans; Retrospective Studies; Erythema Nodosum; Panniculitis; Thrombophlebitis; Tuberculosis
PubMed: 36178454
DOI: 10.1111/jdv.18630 -
The Journal of Trauma Sep 2005
Review
Topics: Adult; Catheterization, Peripheral; Humans; Infusions, Intravenous; Male; Multiple Organ Failure; Multiple Trauma; Sepsis; Thrombophlebitis
PubMed: 16361925
DOI: No ID Found -
Journal of the National Comprehensive... Sep 2008Superficial venous thrombophlebitis (SVT) is characterized as a localized inflammatory condition of the venous vessels underlying the skin. It arises from thrombosis of... (Review)
Review
Superficial venous thrombophlebitis (SVT) is characterized as a localized inflammatory condition of the venous vessels underlying the skin. It arises from thrombosis of a superficial vein, and clinical presentation usually involves pain, erythema, and tenderness at the sites of inflammation. Although the condition is usually self-limited and not serious or fatal, symptomatic superficial thrombophlebitis can be debilitating, limit movement and certain capabilities, or progress to involve the deep venous system and cause pulmonary embolism. SVT is typically associated with venous valvular insufficiency, pregnancy, infection, and prothrombotic conditions, including malignancy. Currently, medical therapies comprising bedrest, elastic stockings, compression bandages, nonsteroidal anti-inflammatory drugs, and low molecular weight heparins are used to reduce the extension of inflammation and recurrence of thrombotic events in patients experiencing SVT. In patients refractory to conservative measures, surgical interventions such as phlebectomy, sclerotherapy, saphenous junction ligation, or saphenous vein stripping are potential treatments.
Topics: Female; Humans; Neoplasms; Pregnancy; Risk Factors; Sclerotherapy; Stockings, Compression; Thrombophlebitis; Varicose Veins
PubMed: 18926088
DOI: 10.6004/jnccn.2008.0057 -
Journal of the European Academy of... Feb 2023
Topics: Humans; Tattooing; Thrombophlebitis; Lower Extremity
PubMed: 35993749
DOI: 10.1111/jdv.18551 -
Journal of the American Academy of... Jun 1990This review concentrates on those disorders in which superficial thrombophlebitis can be a significant or presenting clinical sign. Primary hypercoagulable states are... (Review)
Review
This review concentrates on those disorders in which superficial thrombophlebitis can be a significant or presenting clinical sign. Primary hypercoagulable states are those conditions associated with an increased risk of thrombosis caused by a specific measurable defect in the proteins of coagulation and/or fibrinolytic systems. These disorders are frequently inherited and include deficiencies of antithrombin III, heparin cofactor 2, protein C, protein S, abnormal fibrinolytic activity, dysfibrinogenemia, and Hageman trait. Patients with a lupus anticoagulant and anticardiolipin antibody syndrome with thrombotic episodes are also considered to have a primary hypercoagulable state. The physiology, pathophysiology, clinical characteristics, and treatment of primary hypercoagulable states are reviewed.
Topics: Blood Coagulation; Blood Coagulation Disorders; Diagnosis, Differential; Fibrinolysis; Humans; Skin Diseases; Thrombophlebitis
PubMed: 2196291
DOI: 10.1016/0190-9622(90)70139-9 -
Angiology 2002The current status of superficial thrombophlebitis, including incidence, diagnosis, and management, are reviewed. Treatment options are assessed in the light of data... (Review)
Review
The current status of superficial thrombophlebitis, including incidence, diagnosis, and management, are reviewed. Treatment options are assessed in the light of data from the main studies reported in the literature. These include compression, ambulation, and nonsteroidal antiinflammatory agents and surgical management with high saphenous ligation (with or without saphenous vein stripping) with or without anticoagulants, ranging from aspirin, unfractionated heparin, warfarin, and low-molecular-weight heparin (LMWH). The advantage of the surgical approach is that by ligation with or without stripping of the superficial veins the underlying pathesis (i.e., varicose veins) is also eradicated. In the presence of deep venous thrombosis (DVT), surgery could be combined with anticoagulants. The extensive current literature for DVT treatment shows that the LMWHs are at least as effective and safe as the unfractionated heparins. On this basis, one could reasonably recommend LMWH for the treatment of superficial thrombophlebitis with involvement of the deep veins. Pentasaccharide, a drug that has been recently explored for the prophylaxis and treatment of DVT could be another option. However, there are as yet no data for recommended dosages or duration of treatment for the latter two options.
Topics: Anticoagulants; Bandages; Heparin, Low-Molecular-Weight; Humans; Thrombophlebitis
PubMed: 12463618
DOI: 10.1177/000331970205300605 -
Annals of Emergency Medicine May 2016
Topics: Humans; Thrombophlebitis; Treatment Outcome
PubMed: 26707361
DOI: 10.1016/j.annemergmed.2015.10.018